How the patterns of disease are changing

Over the past 20 years oesophageal carcinoma has undergone a true increase in its incidence in the West. From mid-1990 population statistics, the incidence is about 12 per 100,000 for men and about half this for women.

Worldwide, squamous cell carcinoma (SCC) is the most common cell type but in Western populations it is adenocarcinoma (AC) that is more common and it is ACthat has shown the most worrying increase in incidence in the UK over the past few years.

In this country the ratio of AC to SCC at the moment is around 60:40.

Who is most at risk of this condition?

At-risk groups vary depending on the country you are in, but in the West (where AC is most common) the risk factors are heavy smoking and heavy drinking, and these two factors appear to act synergistically to some extent.

The nutritional factors predisposing to SCC in countries such as China and South Africa for example (diets low in fruit and vegetables) seem to be less important in the UK.

Barrett's oesophagus and, by implication, acid reflux disease is well-known to be a risk factor for AC of the oesophagus and is almost certainly responsible for the rising incidence of AC in the West. Obesity, again through its role in producing acid reflux, has also been shown to be associated with the development of oesophageal AC.

Is the pattern of these diseases changing?

Adenocarcinoma is becoming the predominant cell type in oesophageal carcinoma and interestingly the tumours seem to be moving towards the gastro-oesophageal junction. This is also true for gastric carcinoma that seems to be found increasingly at the cardia of the stomach and more rarely in the antrum. This has led to the suggestion that, even in the stomach, these tumours may be related to acid reflux disease.